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General NPI Number Information
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NPI Number | 1922591080
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Entity Type | Organization
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Legal Business Name | ACA CLINIC
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 23823 EDEN ST
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City | PLAQUEMINE
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State | LA
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Zip | 70764-3315
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Country | US
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Telephone | 225-284-7158
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Fax |
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Provider Business Mailing Address
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Address Line | 59185 POSTELL AVE
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City | PLAQUEMINE
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State | LA
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Zip | 70764-3462
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Country | US
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Telephone | 225-284-7158
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DR. ANDREA ANDERSON PRUITT
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Credential | DNP
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Telephone | 225-284-7158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | LA
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